Correlation between hemorrhage risk prediction score and severe maternal morbidity

Area of Science:

• Obstetrics and Gynecology
• Maternal Health
• Healthcare Quality Improvement

Background:

• Obstetrical hemorrhage is a major cause of severe maternal morbidity and mortality.
• Existing hemorrhage risk scores are primarily linked to transfusion risk, with limited data on non-transfusion-related morbidity.
• The California Maternal Quality Care Collaborative (CMQCC) developed an admission hemorrhage risk score.

Purpose of the Study:

• To evaluate the association between the CMQCC admission hemorrhage risk score and severe maternal morbidity (SMM).
• To assess the score's predictive value for both transfusion-associated and non-transfusion-associated SMM.
• To determine if risk stratification aids in identifying patients at higher risk for adverse outcomes.

Main Methods:

• Retrospective cohort study of delivery admissions from 2018-2019 within a single healthcare network.
• Patients were stratified into low, medium, and high risk using the CMQCC criteria.
• Severe maternal morbidity was defined using ICD codes, ICU admission, or prolonged hospital stay; multivariable logistic regression analyzed the association with risk score.

Main Results:

• Overall SMM incidence was 2.4%; non-transfusion SMM was 0.6%.
• SMM incidence increased with risk strata: 1.6% (low), 2.5% (medium), and 13.6% (high risk) (P<.001).
• High-risk patients had significantly higher odds of SMM (aOR 8.8) and non-transfusion SMM (aOR 3.6).

Conclusions:

• The CMQCC hemorrhage risk score predicts both transfusion- and non-transfusion-associated severe maternal morbidity.
• High hemorrhage risk on admission is strongly associated with increased severe maternal morbidity.
• Risk identification alone may be insufficient; further interventions are needed to mitigate morbidity in high-risk patients.